“Sorry”, my boyfriend at the time was looking down apologetically; “For what?” I said, a little concerned. He gripped about a half-inch of tan skin on his stomach and said “I had takeaway pizza twice last week… I’m not in my best shape”. I looked at the skin he was gripping, stuck between sympathy and envy.

Muscle Body Dysmorphia – also known as The Adonis Complex or ‘Bigorexia’ – is an illness on the rise. There exist no firm numbers of who might be affected, but cases of men who suffer from body dysmorphia – or a warped perception of their physical self – have increased steadily over the last 20 or so years.

Our current understanding of the Complex is that there are men who see a distorted version of themselves in the mirror. What they see, when we see a potentially very attractive man, is a pale, flabby gremlin. They often have conscious if illogical or uncritical understandings of their condition, such as: potential mates prefer substantial muscle (found to be untrue), they are in competition with their peers or they are addressing childhood memories of being labelled ‘fat’ or ‘overly thin’. Or they have no opinion whatsoever on very extreme behaviour

This does not just affect gay men – straight men, out to assert masculinity against the tides of butch feminism, metrosexuality and overt criticism of ‘male-ness’, have been found to have deep-seated anxieties relating to their physical appearance.

But in the gay community a shoring up of insecurities e.g. family, friends and romantic, can be very toxic when we add body anxieties. Gay men are notoriously critical, or ‘bitchy’, about each other; and the club scene asks, in exchange for inclusion, subscription to certain norms. Two of these ‘norms’: drug use and bareback sex, have been well covered in recent times. But little has been said on the subjective field of physical appeal, although this might be the most tangible on any night out in in Soho, London, or Canal Street in Manchester.

It is why the ‘Adonis Complex’ is an appropriate term for muscle dysmorphia in gay men. In the place of divinity, many men idolise male celebrities or porn stars. Gays are well-recognised niche group for marketers to target – most often (if I little lacking in creativity) with homoeroticism. In these images there is no ambiguity about the ‘ideal’ male body.

These ‘relationships’, I would argue, are important – they are channels through which to celebrate and normalise MSM sexuality. But they foster a dark by-product: physical elitism, which is reenforced by popular images of skin-tight (or absent) clothing, unrealistic muscles and rare beauty.

It makes sense that gay men would be obsessive about their body with this images as a dominent feed between gay men and gay-targeted media. Especially for men who participate in ‘mainstream’ gay cultures, such as the club scene. The ultimate standard for the male body has been set by these media. So it is not hard to see why many men, fearing irrelevance if they become old or overweight, can become ‘over concerned’ (to warily use that word) with their physical appearance. This, again, is true in the straight world as in the gay one.

But in the gay world the catalyst – the male form – is everywhere. In our media, in the clubs, on the streets and in our bedrooms (which is, for the most part, lovely). Gay men are presented with the omnipresent male form in any gay niche group (by definition). Even in drag acts, much of the humour comes from the ungainly and overt masculinity of the performers. We have a common ‘currency’ in the male body – we all have one, and we all to one extent or the other desire one romantically and possibly sexually.

This omnipresence compounds our doubt and anxiety. We have no refuge within popular culture nor within groups of gay men. The nature of this is a cycle: as we try and convince others that we belong to this elite standard, we fuel anxieties in others (“Am I as attractive as he is?), as well as our own (“Does he agree with me? Does he appreciate how often I go to the gym?”).

All this is to say that pockets of gay men experience body dysmorphic disorder as a mainstream cultural presence, not an undercurrent. Stereotypes of gay men – which are, effectively, generalisations taken after a superficial glance – often cite vanity, obsessive attention to physical appearance, and obnoxious neurotic behaviours: “do I look fat? I feel fat” “My hair is so awful today” “don’t take a photo of me, I look disgusting!”. These behaviours do not tell us some gay men are arrogant, vain and in need of reassurance, but that they obsess over fine and often insignificant aspects of their looks. And for no other reward other than to wake up tomorrow and repeat.

Obviously: this is the opinion of gay man who has never lived a straight life, nor been exposed to the cultural stimuli of straight men. From this side of divide, however, the pressure to look good seems stronger among gay men then our heterosexual counterparts.

Either way, the pressure is there, and it is toxic. And if it exists among heterosexual men then: what’s good for the goose is good for the gander (without specifying which is which). Professional, personal and romantic lives are affected by a desperation to ‘look good’, without respecting the subjectivity of looking good or the part personality and mentality have to play in attraction. The internal menace of body dysmorphia is an ongoing concern, and one with far-reaching consequences. There may be no absolute solution – but understanding is the key to progress.

Editor’s note: this is a guest post from André Helman, MD; a relational psychotherapist from Paris.

Pink Therapy is an independent therapy and training institution devoted to LGBT people and to gender and sexual diversity. Located in London, it was created by Dominic Davies, a psychotherapist and sex therapist, who runs it together with a team of fifteen or so therapists and trainers.

I was lucky enough to take part in an international summer school about Gender and Sexual Diversity Therapy (GSDT). Exploring this concept, which was brand new to me, as well as its implications was an opportunity for dramatic breakthroughs and broadening of my field of thought. That is the experience I wish to evoke in this paper. It is not an in-depth reflection about GSD (many books were published about it, and many are still to be written), only a brief report where the author’s subjectivity is freely invited.

The GSD concept

Gender and Sexual Diversity (GSD) and Gender and Sexual Diversity Therapy (GSDT) concepts were elaborated through the recent years by Dominic Davies and his colleagues. The initial book, Pink Therapy, which gave its name to the institute, was directed by Dominic Davies and Charles Neal, and first published in 1996. It dealt with affirmative therapy for gay men. Progressively, the wording evolved: gay affirmative therapy turned into gay and lesbian affirmative therapy, and then sexual minority therapy, until the current term GSDT. Indeed, it appeared that the LGBT concept – even when adding an I for intersex or a Q for queer – would not allow to include all patients who were addressed by this therapeutic approach. For instance, this term excludes asexuals, kinksters, swingers, polyamorous, non-monogamous, flexible heterosexuals, fetishists, “objectum sexuals” (people who experience a romantic attraction to an object), the approach would not be consistent if it added an exclusion to those it intends to stand together with.

Every person related to any aspect of GSD suffers a social oppression, with different degrees and specific forms, which induces an internalized oppression, as an identification to the “norm”, and a counter-oppression, as a reaction. For example, the fight against misogynous oppression – wrongly named sexist – generated diverse types of counter-oppression, among which misandry is a major one. The common oppression suffered by all GSD persons can be resumed with five injunctions: meet someone of the other sex, get married, have children stay together for your whole life, be faithful… But “the award for conformity is that everybody loves you… but you”. Within the LGBT(IQ…) “community itself, discrimination and difference rejection are common practice. To be oppressed does not prevent you from being an oppressor.

Group dynamics

Our group consisted of twelve persons, originating from 11 countries: Benin (West Africa), Catalonia, Denmark, Finland, Ireland, Italy, Poland, Scotland, USA and France – and representing many diversities : gays, lesbians, bisexuals, asexuals, flexible heterosexuals, transmen… All of them where psychotherapists, either active or about to complete their training, all of them were very motivated and involved in the process. The course was presented by the same pair every morning (Pamela Gawler-Wright and Olivier Cormier-Otaño), while a different trainer intervened every afternoon, according to the topic.

As soon as the group met first for the time, the leading pair, tactfully and lightly, installed a climate of confidence, mutual respect and freedom of speech which greatly contributed to the quality and profoundness of our sharing throughout the course. Their interventions were rich with information and experiences. Together with the proposed exercises they both inflamed me and confronted me with my limits, my questioning, my fears. Each afternoon trainer, in their own special way, contributed to these dynamics. Each participant was invited to share in how they experienced the exercises as well as their own personal and professional experience, as related to the discussed topics. They all did so with a great sincerity, which allowed me to discover some aspects of GSD, I knew nothing about, to be confronted to my own stereotypes and prejudices, and, eventually, to dramatically change my viewpoint about some of them.

The course main lines

Many issues were developed, discussed and deepened through practical exercises. Below, I mention the main ones and what I experienced when tackling them.

Stereotypes and prejudices

As with everybody, our patients carry all kinds of stereotypes and prejudices, which partly contribute to generating and/or maintaining their unwellness. Therapist do too! This contributes to narrow our vision of our patients, our capacity to accept them fully as they are and, consequently, the quality of our support. Without taking the expression “The cobbler’s children go barefoot” at face value, we all should continue to explore and challenge our own stereotypes and prejudices, aiming at getting free from them. As far as I am concerned, this course greatly helped me in this respect. Work is still in progress…

Is my therapist GSD?

Choosing a therapist one considers as heterosexual or, on the contrary, as identically oriented is not neutral. It’s worth exploring what such a choice implies. For instance:

The fear a GSD person may experience about confiding in a heterosexual therapist may come from their own heterophobia: to believe a heterosexual therapist is deductively unable to support a GSD patient; conversely, the belief that choosing a same GSD oriented therapist is a sufficient condition is limiting too: it cannot be the only criterion for a successful therapy.

As regards a same oriented therapist, there is a risk of collusion (I understand them as I experienced the same thing as they do) or identification (I experience the same thing as they do so what they say relates to me personally).

To say or not to say whether I’m GSD: it was very helpful for me to participate in a discussion about this issue. Is it right to answer the patient’s question “Are you gay?” and how to do it?

Lesbianism and lesbophobia

Through “life stories” of Anglo-Saxon lesbian celebrities, illustrated by animated and musical presentations, Pamela Gawler-Wright lightly introduced us to the yet awful word of social persecutions which lesbians experienced since some of them started to claim their visibility and right to be themselves.

Coming out

Half a day was devoted to the coming-out issues. In particular, the following topics were addressed:

Coming out is multiple: one experiences as many coming outs as there are situations and persons one has to face throughout one’s life; thus, it’s repeated many times, in a different way every time.

As the consequences of coming out are unknown, it necessarily makes the person feel unsafe.

It’s hard to resist the belief “It should be known” (transparency as a moral value).

Shame, vulnerability and internalized oppression

Another half-day permitted to develop and deepen this issue, through exercises in which participants got very involved. As far as I am concerned, it was overwhelming and it taught me a lot. In particular, it presented me with an opportunity of experiencing a real breakthrough about the self-maintained process of superego injunctions.

I feel internalized oppression is a core issue for many of our patients, specially – but not only – our GSD patients. It’s likely to be one the most widely shared psychological processes. Even white heterosexual men cannot escape it (at least not all of them…): many of them have internalized the oppression of sexual performance obligation or that of aggressive machismo as inseparable from their manhood (a young male, smart, open-minded patient recently told me “if I climb stairs behind a woman – as any gallant man should do – and she wears a miniskirt, what will she think about me?”)

For many GSD persons, social oppression is very deep as it is rooted in gender difference. Internalizing it induces the shame of being oneself as well as radical judgements about one’s own desires, thoughts and acts. This shame causes vulnerability and hypervigilance regarding anyone or anything that could question this aspect of the person’s identity. But to be vulnerable does not mean to be weak: on the contrary, accepting one’s vulnerability is a major strength which contributes to coming out of shame and of internalized oppression.

In any case, the psyche authority that judges and pronounces irrevocable condemnations – whether you call it cruel superego or “top dogs” – plays a major part in maintaining shame, especially by justifying it endlessly. If we consider it as a major target of the therapeutic process, it can only benefit to our patients.

Asexuality

Discovering asexuality was one of the highlights of the course for me, particularly as we could take advantage with direct testimonies. Furthermore, Olivier Cormier-Otaño presented us with an enthralling study he conducted via a questionnaire that reached 310 persons considering themselves as asexual. In our hypersexual society, asexuality stands as a very strange, incomprehensible phenomenon. For us, psychotherapists, it shocks our “knowledge” about sexuality and its issues… where it finds no place. It’s our responsibility to give it its right place if we want to be able to support asexual persons along their way to feel at peace with themselves and get integrated in their environment.

Transsexuality

Here again, direct testimonies were a major contribution to the course. I had already read books and articles on this topic, but coming to meet persons who experience transsexuality is irreplaceable. We heard a presentation about the activity of the Tavistock Clinic service dealing with children and teenagers who question their gender – the only service of this kind in the UK. It threw light on how to welcome and answer their questioning, both on a human and medical level.

“Help me not be gay!”

Conversion therapies, even though in loose momentum, still exist in Anglo-Saxon countries – maybe in France, as well, I don’t know. Without going so far, all of us may have to face a person whose request is to help them stop experiencing feelings and emotions related to GSD. How should we meet this request? How can we support them in their quest for an inner harmony, without letting ourselves being carried away by a “pro-GSD” ideology?

Behind such a request, as behind any request concerning identity, there are beliefs, grounded on stereotypes, and which appear to the person as truths, as certitudes. The suggested approach aims at helping the person to see truths as beliefs and to realise that beliefs are not the truth (my simplification…).

As a provisional conclusion

A word imposes itself to me after this experience: empowerment. I could say, feeling confident and deeply free, because of the recognition of my responsibility towards GD persons and my capacity to face it.

I never so clearly realised the pressing urge to acknowledge, accept and welcome human diversity, whatever its form and expression, as well as to challenge the stereotypes and prejudices it inevitably reveals to me.

The GSD concept is just emerging. It’s hardly starting to contribute redesigning the outlines of our ‘community’ and to influence the way we look at our patients, and perhaps at our practice. Meeting GSD persons who embody some GSD aspects I didn’t know, or about which I had rather bulky prejudices, helped me a tremendous lot in accepting them better, hence feeling better with myself and more open to my patients.

With the recent events in Russia over the state of LGBT+ rights and acceptance, we thought it might be interesting to point out a recent event which caused some concern.

During the revision of the Professional Competencies for Psychotherapists in Europe being drafted by the European Association for Psychotherapists (EAP) it was noted by one of our Directory members, psychologist Dr Greg Madison that the extensive document held in it no mention of sexual minorities as ‘stimagtised’ groups. For a relatively sizeable ‘minority’ this appeared to be a glaring omission.

And it was. On closer examination it was confirmed that no mention of sexualities was given, although issues of gender had been. Pink Therapy founder, Dominic Davies contacted Tom Warnecke Vice Chair of UKCP to express his concern and an amendment was quickly proposed.

The issue itself is worth commenting upon, not simply because of the state of LGBT+ rights in Europe as of global interest, but for the concern raised when the sexualities are excluded from information that creates more understanding therapeutic support for stigmatised groups.

The Executive Council of EAP meeting occurs this month in Moscow, in which the amendment, which has now garnered additional support from the Irish Council for Psychotherapy, will be reviewed.

It is hoped that the location of this meeting will not affect the outcome of this particular amendment, and in the new Competencies there will be due consideration of sexual minorities.

Most within the LGBT+ community will be aware of Russia’s growing presence in the news stream for anti-gay political action. The most recent piece of news, reported here on the 11th of June by the BBC, has been the passing of ban on anti-gay propaganda. The video also reports on the anti-gay sentiment still apparent and even encourage in Russia today.

In light of which, PT offers a reminder that some of our resources are available in Russian. This is in the hope that these will be available to Russian people affected by the ban and to remind them that what is being promoted by the Russian government is unjustified and cruel, and no reflection on them.